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Contemporary approaches to the study of hysteria, clinical and theoretical perspectives
  1. B Toone

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    Edited by Peter W Halligan, Christopher Bass, and John C Marshall. New York: Oxford University Press, 2001, £75.00, pp 346. ISBN 019263254X

    This book ranges more widely than its title implies, including sections on somatisation disorder, factitious disorder, and malingering. Indeed, much the same territory as covered by Somatisation, also edited by Christopher Bass and published in 1992. A comparison of the two multi-authored compilations provides a fair indication of progress over the past decade.

    Perhaps the most positive development is that the Slaterian heresy (that to diagnose hysterical conversion is to miss an organic disorder) seems finally to have been laid to rest. Hysterical conversion, conversion, dissociation—whatever you care to call it—exists, the problem is: what is it? The paradox is laid bare in a chapter by Wessely: Conversion is a psychiatric disorder that is diagnosed by neurologists on essentially negative grounds. The so called positive features—for example, primary gain—can rarely be convincingly elicited, which is hardly surprising: a conscious awareness of primary gain would vitiate the whole conversion process. The lack of a firm theoretical basis worries most authors, but thoughtful sections on functional neuro-imaging (in spite of there being little data) and the role of hypnosis point the way forward. Clinical interests are well served: in particular chapters on prognosis and on neurological assessment. The editors have strained to achieve a balance between the old and the new: the price to be paid for this is three chapters on psychodynamic theory where one would more than suffice. This apart, the book provides an excellent tour d’horizon of hysteria and allied disorders as they enter the 21st century.